SURNAME* FIRST NAME* ADDRESS - Mailing (City / Town and Postal Code*Local Phone*EMAIL* CLAIMING WAGES? Yes No DIRECT DEPOSIT? Yes No IF 'Yes' BANKING INFO MUST BE SUBMITTED ACTIVITY INFORMATION- REQUIREDACTIVITY ASSOCIATED WITH CLAIM*SelectMeetingConferenceTrainingNAME OF ACTIVITY* EXPENSE TRAVEL Check all that apply. Mileage MILAGE Milage Input* KM @ $0.57Travel - Milage ResultParking PARKING Parking Input*Travel- Parking ResultTAXI TAXI Taxi Input*Travel - Taxi - ResultOtherr OTHER Other Input*Travel - Other - ResultTravel TotalTravel TotalPlease specify nature of other expenses* ACCOMMODATION Check all that apply. Hotel HOTEL hotel Input*Accommodation - Hotel - ResultPRIVATE ACCOMMODATION/LODGING PRIVATE ACCOMMODATION/LODGING How Many Days?*DAYS @ $50.00Private accomodation resultMEALSLEFT HOME DATE* MM slash DD slash YYYY TIME* : Hours Minutes AM PM ARRIVED HOME DATE* MM slash DD slash YYYY TIME* : Hours Minutes AM PM Check all that apply (Effective Date: April 1, 2021))BREAKFAST BREAKFAST Breakfast Input* @ $21.10Meals - Breakfast resultLUNCH LUNCH LUNCH Input* @ $21.35Meals -Lunch resultDINNER DINNER Dinner Input* @ $52.40Meals - Dinner resultINCIDENTALS INCIDENTALS INCIDENTALS Input* @ $17.30Meals - Incidentals resultTravel TotalMeals TotalWAGES (includes top-up) For Treasury Board and CSE members claiming wages – please attach your approved leave document before submitting this form.CLASSIFICATION & LEVEL DAILY RATE $ DAYS CLAIMED DAILY RATE TOTALAdd field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 2Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 3Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 4Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 5Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 6Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 7Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 8Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 9Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 10Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 11Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 12Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 13Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 14Add field +DAILY RATE $ DAYS CLAIMED DAILY RATE TOTAL 15MISCELLANEOUS Check all that apply. FAMILY CARE CLAIM FAMILY CARE CLAIM $*Misc - Family Care resultOTHER OTHER Description* Amount*Other Bottom ResultDescription AmountOther Bottom Result TwoAdd field +HiddenDescription HiddenAmountHiddenAdd Result 1Add field +HiddenDescription HiddenAmountHiddenAdd Result 2Add field +HiddenDescription HiddenAmountHiddenAdd Result 3Add field +HiddenDescription HiddenAmountHiddenAdd Result 4Add field +HiddenDescription HiddenAmountHiddenAdd Result 5Add field +HiddenDescription HiddenAmountHiddenAdd Result 6Add field +HiddenDescription HiddenAmountHiddenAdd Result 7Add field +HiddenDescription HiddenAmountHiddenAdd Result 8Add field +HiddenDescription HiddenAmountHiddenAdd Result 9Add field +HiddenDescription HiddenAmountHiddenAdd Result 10Miscellaneous TotalMiscellaneous TotalDID YOU RECEIVE AN ADVANCE? Yes No IF 'Yes' INDICATE THE AMOUNT*Advance TotalComments Please provide any additional information or requests that are relevant to your claimComment BoxNET CLAIM (before statutory deductions)TOTAL ALL EXPENSES To help faster processing: Include all receipts For Treasury Board and CSE members claiming wages – please attach your approved leave document before submitting this form. Include FAMILY EXPENSE FORM (if applicable) If DIRECT DEPOSIT was requested, please include a copy of a void cheque PDF, .jpg, .png, .docx files accepted max 10MB file size. ATTACH FILES Drop files here or Select files Max. file size: 200 MB. * By checking this box, I certify that these expenses indicated were incurred for Union Business and that not part of said expenses were or will be reimbursed from any other source